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Holly Hovan's picture

Holly Hovan MSN, RN-BC, APRN, CWOCN-AP

Diabetes is extremely prevalent in the United States. The Centers for Disease Control and Prevention (CDC) report that over 10% of the US population has this chronic disease, and 26.8% of older adults (65 and over) are impacted by diabetes, both diagnosed and undiagnosed.

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Michel Hermans's picture
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By Michel H.E. Hermans, MD

How should I treat a patient with a partial-thickness burn on less than 10% of their body but poor vascularity?

It is not possible to give a specific answer to this question because burns larger than 10% could be anywhere from 11% to 99%. As mentioned in the presentation, larger burns cause burn disease with all its potential complications. “Poor vascularity” is a bit vague. If it is the result of diabetes, then the disease itself, including the typical microvascular problems, will contribute to poorer healing. On the other hand, peripheral arterial disease usually does not have a significant impact on the healing of partial-thickness burns unless occlusion is very severe.

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By Roshni Patel, BSc (Hons), MCOptom

The cornea, as we know it, is a complex and fast-healing tissue that provides protection from infectious and non-infectious defects. However, it can still be injured through environmental impacts or surgical procedures, such as cataract operations or laser-assisted in situ keratomileusis (LASIK), as well as traumatic injuries. Although most corneal wounds repair themselves without further drawbacks, possible complications may occur and delay the healing process. This blog outlines the natural healing process of corneal wounds and post-surgical wound healing, as well as the obstacles to healing that may occur in diabetic patients.

Luis Fernandez's picture

By Luis Fernandez, M.D., KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS

Complex wounds have plagued humankind for thousands of years, and the search for methods to combat infectious agents has been met with limited success. Although silver, iodine, and honey still hold a place in a long list of treatments employed today, in general, these and other antimicrobials have at least one thing in common: unlike pure hypochlorous acid (HOCL), none of them are native to humans (iodine is not present in humans in an antimicrobial role).

WoundSource Practice Accelerator's picture

Patients who develop stage 3 and 4 pressure injuries with prolonged wound chronicity and complexity may require surgical intervention. One surgical method used to encourage healing in pressure injuries is flap surgery, which involves taking a section of skin with an intact blood supply and placing it over the injured area. Flaps play a major role in the healing of wounds with exposed structure. Flap surgery can help prevent hospitalization and decrease morbidity. Flap surgery is used to prevent and resolve complications, including surgical site infections and other infections, dehiscence, recurrence, flap necrosis, nutrient deficiencies, and prevention of future malignancy (Marjolin ulcer) and seroma or hematoma.

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WoundSource Practice Accelerator's picture

When pressure injury prevention fails as a result of non-adherence, various comorbidities, or gaps in care, it makes a major impact on the nation’s economy and has estimated costs of more than $100 billion in the United States.

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WoundSource Practice Accelerator's picture

Pressure injuries are among the most significant health and patient safety issues that health care facilities face daily. Aside from the strong impact on patients’ quality of life, they also have high costs of treatment, not just to the patient, but also to the health care industry. The Agency for Healthcare Research and Quality reported $20,900 to $151,700 per individual patient and pressure injury in health care costs. The prevalence of present-on-admission (POA) pressure injuries is 26.2% among those admitted to the hospital from a nursing home and 4.8% among those admitted from another living setting. Hospital-acquired pressure injuries (HAPIs) cost the US health care system $9.1 to $11.6 billion a year.

WoundSource Practice Accelerator's picture

The coronavirus disease 2019 (COVID-19) pandemic has forced health care professionals to take a closer look at the most effective and appropriate measures for pressure injury prevention. In 17% of all COVID-19 cases pneumonia secondary to acute respiratory distress syndrome is the most common complication; therefore, prone positioning is used as an adjuvant therapy. The prone position allows for dorsal lung region recruitment, end-expiratory lung volume increase, and alveolar shunt decrease. To be most effective, this position should be maintained for 10 to 12 hours, thereby increasing prolonged pressure on certain areas of the body. However, prone positioning should be supervised and monitored regularly by nursing staff experienced with this positioning technique.

WoundSource Practice Accelerator's picture

Adherence: Adherence is a term used to replace "compliance" in reference to a patient following clinician orders for wound care. Compliance implies that the patient should passively comply with the health care provider’s instructions, whereas adherence allows for patients to have the freedom to follow the provider’s recommendation without blame being focused on them if they do not or are not able to follow these recommendations.

Medical device–related pressure injury (MDRPI): MDPRIs are localized injuries to the skin or underlying tissue resulting from sustained pressure caused by a medical device, such as a brace, splint, cast, respiratory mask or tubing, or feeding tube.

Offloading: Offloading refers to minimizing or removing weight placed on the foot to help prevent and heal ulcers, particularly those caused by poor circulation to the feet due to diabetes.

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WoundSource Editors's picture

By: Dianne Rudolph, DNP, GNP-BC, CWOCN

What are some ways to achieve insurance coverage for fistula pouches or to use ostomy supplies for a fistula? We often run into the issue of supplies not being covered for Medicare or Medicaid patients.

Unfortunately, coverage is inadequate. CMS (Centers for Medicare & Medicaid Services) coverage for fistulas is limited for fistulas caused by or resulting from a surgical procedure, and even then, it may be difficult to get reimbursed. Spontaneous fistulas (15% to 25%) are generally not covered. The Wound, Ostomy and Continence Society is working on trying to effect a change in coverage. Some insurance companies may be more amenable to reimbursement, and it may require a case-by-case application or appeal. For patients being discharged home, it may be possible to secure a short-term supply of 10 to 14 days. The cost for the pouches may run $255 and up for a box of 10.